Arthroscopic Graft Reconstruction for Nonrepairable Scapholunate Ligament Injuries

Disruption of the scapholunate intercarpal ligament (SLIL) remains one of the most challenging wrist pathologies to treat. As this injury progresses, diastasis of the scapholunate interval and secondary carpal malalignment occur, leading to abnormal motion and arthritis. Acute injuries may be repairable, but delayed presentation is common, in which the ligament cannot be fixed primarily. Many reconstructive procedures have been described that improve clinical function, but outcomes are variable and no procedure reliably prevents arthrosis. Some of this variability may be related to disruption of secondary stabilizers during open approaches, which motivated the development of arthroscopic interventions. Arthroscopic SLIL reconstruction is technically demanding but maintains secondary stabilizers and capsular vascularity and allows for treatment after arthroscopic evaluation. We describe an arthroscopic reconstructive technique to re-create the volar and dorsal SLIL while reconstructing the long radiolunate ligament. This approach causes minimal soft-tissue disruption and allows for earlier mobilization compared with open procedures. With arthroscopy being critical to the diagnosis and treatment of SLIL injuries, a reliable arthroscopic reconstructive technique is a vital tool for any surgeon treating this pathology.